Provider Demographics
NPI:1700179637
Name:BORUM, MONICA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DENISE
Last Name:BORUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 GARDENWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3212
Mailing Address - Country:US
Mailing Address - Phone:404-763-8555
Mailing Address - Fax:404-763-8502
Practice Address - Street 1:5524 OLD NATIONAL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3212
Practice Address - Country:US
Practice Address - Phone:404-763-8555
Practice Address - Fax:404-763-8502
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN079640164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse